We are not out of the woods yet… But maybe the answers lie within the trees?

As we emerge from lockdown and adapt to the ‘new normal’, we must recognise the impact of the Covid-19 pandemic on our psychological wellbeing and discuss ways to heal and move forward. This is all the more difficult as the pandemic has limited access to community and health support (Durcan et al, 2020; Reger et al, 2020).

A national trauma-informed approach

The pandemic is considered a ‘mass trauma’ (Horesh & Brown, 2020). If individuals and groups are suffering trauma symptoms across the country, a national trauma-informed approach might be needed; one which is sensitive, understanding of the varied adverse impacts of government measures across society and allows for a diverse community response. 

A trauma-informed approach would seek to create safe environments for those affected by trauma, rather than direct therapy or interventions, and prioritise the importance of relationships in building resilience against the psychological consequences of trauma (Levenson, 2017). Trauma-informed approaches often follow six key principles: safety, trustworthiness, choice, collaboration, empowerment and intersectionality (Bowen & Murshid, 2016).

Arguably, the country’s response to the pandemic has compromised some of these key trauma-informed principles, however necessary. Our sense of individual and collective ‘safety’ has been compromised, our ‘choice’ has been removed in how we control our daily lives and ‘empowerment’ may have been lost in a pervasive feeling of powerlessness. ‘Trustworthiness’ may have been damaged in the government’s handling of certain aspects of the pandemic and it is clear that some minority groups in the UK have suffered more than others, particularly the Black and Minority Ethnic (BAME) community, undercutting ‘intersectionality’. 

A national trauma-informed approach may overcome these issues, which will be all the more crucial if the country is to face a second wave of Covid-19. The advice of the Independent Scientific Pandemic Influenza Group on Behaviours (SPI-B) has already included foundations for a trauma-informed approach, including the government providing ‘clear and transparent reasons for different strategies’ and promoting ‘a sense of collectivism’ (SPI-B, 2020). This highlights the need to reinforce a sense of collaboration and trust in leaders. 

In order to improve feelings of safety, empowerment and intersectionality, the Centre for Mental Health recommended several practical means by which the government can use a trauma-informed approach to begin the healing process (Wilton, 2020). This could include a nation-wide strategy to normalise trauma responses in the wake of the crisis and provide accessible information to validate individual experiences. Furthermore, there must be space for minority or unheard groups to voice their need for tailored support and readily available and accessible emotional support in communities, workplaces and schools (Wilton, 2020). 

Importantly, if there is a national acceptance of the trauma response to the pandemic along with a drive to provide individuals and communities with information to empower their recovery and healing process, individuals may be encouraged to seek the support they need. The ways in which communities organise their support is an important feature in healing from trauma (SAMHSA, 2014) and therefore, any healing initiatives need to cater for the diverse needs of communities across the country.

The Tree of Life: Understanding our stories of the pandemic

One framework that could be useful in healing communities and allowing for diversity in healing is the Tree of Life (ToL), developed by Ncazelo Ncube in Zimbabwe as a tool to support vulnerable and grieving children affected by the HIV/AIDS crisis. The ToL uses metaphors and questions to empower people to shape their life stories into ones of strength and hope in the face of adversity (Ncube, 2006). 

The underlying principle of ToL is that our understanding of our own lives is based upon the meanings we prescribe to our experiences; and that any problems in a person’s life or identity is intrinsically tied to the political and social context in which they exist. Importantly, ToL can be used in any community as the emphasis is on individuals and groups recognising that they are the author of their own lives and can use their own cultural practices and collectiveness to change stories of trauma and loss into stories of resilience (Lock, 2016). Based on Ncube’s (2006) work, the ToL involves individuals drawing a tree, the main elements of which have a narrative focus:

• Roots represent cultural and familial origins
• Ground represents where one lives and their day to day activities
• Trunk represents skills, memories and experiences
• Branches represent hopes, dreams and wishes
• Leaves represent significant others
• Fruits represent gifts, either material or emotional

We might consider that the current pandemic has shaken the ground of a person’s ‘Tree’ in that lockdown measures have fundamentally changed how people live their day to day lives. Likewise, a person’s branchesmay be troubled, in that one’s hopes and wishes for the future are now uncertain, with no clear endpoint for health and economic hardships. For many people in society, leaves may have fallen from their trees if they have lost family members or friends to the virus.

Empowering individuals to re-author their experiences of the pandemic using the ToL could aid in building resilience. Lock (2016) highlighted three processes for success with the ToL:

1. ‘Deconstruction of dominant problem stories’, whereby individuals re-author the negative impact of the pandemic in a strengths-based way. For example, focussing on how lockdown may have provided time to enrich new skills, reason to reconnect with family and friends or space to slow down and live in the moment. The experience of living though the pandemic may empower individuals to recognise new identities for themselves or new paths they want to take in life.
2. ‘Development and enrichment of preferred stories’, whereby individuals ensure that new stories on their Tree are harmonious with their culture (roots) and then use this story to understand how their hopes and dreams (branches) may have changed or can still be achieved, albeit in a different way than before the pandemic. This story can ultimately build resilience through identification of one’s strengths.
3. ‘Living and witnessing preferred stories.’ In the current pandemic, this could involve the sharing of one’s new story and strengths-based approach with others. In being witnessed and validated, the stories are given significance and the person’s new identity is accepted.

Growing our forests to weather the storms

By sharing ‘Trees’, groups and communities can form a ‘Forest of Life’ to understand the growth of individuals throughout the pandemic. This connectedness can build trust and each member can facilitate the further growth of others by recognising, and identifying with, unique narratives. It can also help communities strengthen their bonds to brave ‘the storms of life’, whether those are future waves of Covid-19 or long-term economic, emotional and social hardships. Forming a strong bond through their collective ‘Forest’ would ensure communities understand where their strengths lie and how best to deploy the resources available to them, both physical and psychological, to tackle further lockdowns and government restrictions. 

The ToL offers individuals the chance to connect with their own trauma experiences and, just as importantly, encourages community connectedness. Perception of ‘community’ will vary between individuals, from schools to workplaces, spiritual groups to close-knit neighbourhoods and so on. Equally, the country as a whole can be considered a community and thus a nationwide effort will be needed to empower people to take authorship of their own experiences. 

Combining the ToL with a robust trauma-informed strategy will allow for considerable diversity in the healing process across the country between individuals and communities. The past trauma and current adversity of some of our most marginalised and disadvantaged groups will affect their psychological wellbeing and recovery process. Divisions and inequalities must not be exacerbated by a lacklustre response. In coming together to form our ‘Forests of Life’, we can acknowledge that, even though we are not out of the woods yet, we are collectively building our resilience to be in the best position possible to weather any future storms.

-       Jack Newton, Assistant Psychologist, Mersey Care NHS Foundation Trust 

See also: Mighty oaks from acorns grow – Stella Gkika and Elaine Swift cultivate multidisciplinary trees of strength and resilience

Key Sources

Bowen, E.A. & Murshid, N.S. (2016). Trauma-informed social policy: A conceptual framework for policy analysis and advocacy. American Journal of Public Health, 106(2), 223-229.

Durcan, G., O’Shea, N. & Allwood, L. (2020). Briefing Covid-19 and the nation’s mental health. Forecasting the needs and risks in the UK: May 2020. Centre for Mental Health. Retrieved from
https://www.centreformentalhealth.org.uk/sites/default/files/2020-05/CentreforMentalHealth_COVID_MH_Forecasting_May20.pdf

Horesh, D. & Brown, A.D. (2020). Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities. Psychological Trauma: Theory Research, Practice and Policy, 12(4), 331-335.

Levenson, J. (2017). Trauma-informed social work practice. Social Work, 62(2), 105-113.

Lock, S. (2016). The Tree of Life: A review of the collective narrative approach. Educational Psychology Research and Practice, 2(1), 2-20.

Ncube, N. (2006). The Tree of Life Project: Using narrative ideas in work with vulnerable children in Southern Africa. International Journal of Narrative Therapy and Community Work, 1, 3-16.

Reger, M.A., Stanley, I.H. & Joiner, T.E. (2020). Suicide mortality and coronavirus disease 2019 – A prefect storm? JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.1060

Independent Scientific Pandemic Influenza Group on Behaviours (SPI-B; 2020). SPI-B return on risk of public disorder. Retrieved from
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/873736/08-spi-b-return-on-risk-of-public-disorder.pdf  

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a trauma-informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Wilton, J. (2020). Briefing 56: Trauma, mental health and coronavirus. Supporting healing and recovery. Centre for Mental Health. Retrieved from
https://www.centreformentalhealth.org.uk/sites/default/files/2020-05/CentreforMentalHealth_Briefing56_Trauma_MH_Coronavirus_2.pdf